Prof Nadey Hakim

Prof Nadey Hakim

Imperial College London,UK

Title : Laparoscopic versus Finger Assisted Open Donor Nephrectomy Techniques: where do they stand?

Abstract:

Introduction:

Advances in minimally invasive surgery for live kidney donor’s nephrectomy have led to the widespread use of laparoscopic technique as a standard of care. However, progress has also occurred with open techniques. The aim of the study was to compare an innovative finger assisted open donor nephrectomy (FAODN) technique versus standard laparoscopic living donor nephrectomy (LDN).

Materials and methods:

Description of FOADN technique will be presented. Laparoscopic hand assisted technique was used for comparison. Retrospective data was collected for donor age, gender, race, surgical parameter, hospital length of stay, cost, and 1 year donor renal function (serum Creatinine and GFR) using two different institution's electronic databases (UVA and KCL), The analyses included 95 donors in each group during a similar period of time. Collected variables were compared using Fishers Exact Test for 2x2 tables and Likelihood Ratio Chi-Square for larger tables.

Results:

Overall donor clinical and demographic characteristic were similar between groups. The FAODN group had more males donors (48.4% vs. 51.6% p=0.03), while the LDN group had a statistically significantly larger number of females donors (70.5% vs. 29.5%, p=0.003). Median body mass index (BMI) was similar between groups (28 vs. 26, p=0.032). Left nephrectomy was overall preferred in both groups. Overall frequency of minor postoperative complications was significantly lower in the FAODN group as compared to the LDN group (14.7% vs. 31.6%, p=0.0094). However, rates of hernia, operative blood transfusions and postoperative bleeding episodes were not statistically significantly different between groups. LDN group demonstrated a significantly higher creatinine (1.1 vs. 0.9 mg/dl, p<0.001), and a significantly lower donor GRF at 1 year (60 vs. 89 ml/min/1.73m2, p-value<0.001) post donation. Surgical parameters demonstrated a significant longer surgery time (3.5 vs. 1.2 hrs, p<0.001), a longer combined length of incision (6 vs. 5 cm., p=0.001) and higher cost in LDN group , while demonstrating a statistically significantly shorter median hospital length of stay (3 vs. 4 days, p<0.001).

Conclusion: Our study demonstrates that FAODN is a successful alternative to laparoscopic techniques. It appears to provide renal donors a favorable outcome in terms of complication, surgery duration, and renal function at 1 year post donation.

Advances in minimally invasive surgery for live kidney donor’s nephrectomy have led to the widespread use of laparoscopic technique as a standard of care. However, progress has also occurred with open techniques. The aim of the study was to compare an innovative finger assisted open donor nephrectomy (FAODN) technique versus standard laparoscopic living donor nephrectomy (LDN).

Materials and methods:

Description of FOADN technique will be presented. Laparoscopic hand assisted technique was used for comparison. Retrospective data was collected for donor age, gender, race, surgical parameter, hospital length of stay, cost, and 1 year donor renal function (serum Creatinine and GFR) using two different institution's electronic databases (UVA and KCL), The analyses included 95 donors in each group during a similar period of time. Collected variables were compared using Fishers Exact Test for 2x2 tables and Likelihood Ratio Chi-Square for larger tables.

Results:

Overall donor clinical and demographic characteristic were similar between groups. The FAODN group had more males donors (48.4% vs. 51.6% p=0.03), while the LDN group had a statistically significantly larger number of females donors (70.5% vs. 29.5%, p=0.003). Median body mass index (BMI) was similar between groups (28 vs. 26, p=0.032). Left nephrectomy was overall preferred in both groups. Overall frequency of minor postoperative complications was significantly lower in the FAODN group as compared to the LDN group (14.7% vs. 31.6%, p=0.0094). However, rates of hernia, operative blood transfusions and postoperative bleeding episodes were not statistically significantly different between groups. LDN group demonstrated a significantly higher creatinine (1.1 vs. 0.9 mg/dl, p<0.001), and a significantly lower donor GRF at 1 year (60 vs. 89 ml/min/1.73m2, p-value<0.001) post donation. Surgical parameters demonstrated a significant longer surgery time (3.5 vs. 1.2 hrs, p<0.001), a longer combined length of incision (6 vs. 5 cm., p=0.001) and higher cost in LDN group , while demonstrating a statistically significantly shorter median hospital length of stay (3 vs. 4 days, p<0.001).

Conclusion: Our study demonstrates that FAODN is a successful alternative to laparoscopic techniques. It appears to provide renal donors a favorable outcome in terms of complication, surgery duration, and renal function at 1 year post donation.

Biography:

Nadey Hakim qualified from Paris Descartes University in 1984. Laureate of the Faculty of Medicine Cochin Port Royal. Surgical training Guy’s Hospital, PhD from University College London. Gastrointestinal Fellowship Mayo Clinic and Transplant Fellowship University of Minnesota. Has published over 150 peer-reviewed papers and has written/edited 23 textbooks in the field of General, Transplant and Bariatric surgery. Has successfully started the first Pancreas Transplant Program in the SE of England. He is the First Max Thorek Professor of Surgery. He is a Professor of Transplantation Surgery at Imperial College London. He was awarded Honorary Professorships from Lyon University, Ricardo Palma Lima Peru University, Bashkent Ankara University, University of São Paulo and was Visiting Professor at several institutions worldwide including Harvard and the Cleveland Clinic. He is the Envoy of the Imperial College President. He was the 35th President of the International College of Surgeons. Was awarded the 2007 J. Wesley Alexander Prize for outstanding research in the field of Transplantation. London School of Surgery Transplant Tutor 2008 to date. Vice President Royal Society of Medicine (2014-2016). Governor American College of Surgeons UK Chapter (2014-2020). Chevalier de la Legion d’Honneur (2016). Ambassador of the All Party Parliamentary Group (APPG) UK House of Commons (2018-). Membre de l'Academie Francaise de Chirurgie.